Healthcare in India is unique in having indigenous or “Indian Systems of Medicine” (ISM), recognized for delivering healthcare in addition to Allopathy. Ayurveda, Yoga, Unani, Siddha, and Homeopathy, collectively known by the acronym “AYUSH”, have co-existed for years in their individual compartments along with Allopathy. Recent attempts to permit a person qualified in one system of medicine to prescribe drugs from another system commonly referred to as cross-practice has created a vexatious issue; and a brief review of the systems is in order
Ayurveda: This system has been traced back to 3000 B.C., and is based on the three “doshas” namely, “Vata” (air) “Pitta” (fire) and “Kapha” (water). Disease it assumes, results from an imbalance or malfunction of one or more of these humors or doshas. Therapy aims at “Tonification or Reduction”. Medication is derived from plants, animals, metals, minerals, jewels and gems, converted into fine powders called “bhasmas”. It is an evolved science based on subjective experiences handed down by saints verbally or in historical writings. Scientific scrutiny therefore does not apply.
Yoga: Being a system of exercises and lifestyle, does not involve any medication and therefore no conflict arises.
Unani: Is of Greek origin dating back to 1025 AD with a significant contribution from the Arabs who brought it to India in the 12th century AD. It is based on the 4 humors; “Dam” (blood), “Balgham” (phlegm), “Safra” (yellow bile) and “Sauda” (black bile). Humoral balance is maintained by “Quwwat-e-Mudabbira” an inborn power, and disease results from an imbalance. Therapy includes venesection, diuresis, purging, leeching, and dieting.
Siddha: Goes back 10,000 years and is the ancient Hindu system practiced mainly in Tamil Nadu and adjacent Tamil speaking areas. It identifies the “panchabhuthas” or five elements of gold, lead, copper, zinc and iron; with earth and water making up the human body; and air and ether the soul. Heat and water combine the two. Metals are used in therapy and the concept of extrinsic factors is not recognised.
Homeopathy: Is attributed Samuel Hahnemann in 1796; the word is Greek in origin and the system is based on the principle of treating like with like, or the law of “Similia similibus curentur”. Drugs are derived from plant, mineral, and animal sources and serial titrations and dilutions carried out to reduce toxicity and arrive at therapeutic doses.
Allopathy: Relies on the principle of cause and effect. Headache is the effect; it has a cause which is determined and both cause and effect treated. Unlike the ISMs, the treatment modalities of Allopathy undergo a rigorous system of research, laboratory testing and peer review: and even then there are mishaps.
Even a brief synopsis like this establishes that the systems and their philosophies are totally incompatible with each other, and there is as much room for the “mix and match” approach as there is in mixing oil and water. The recent overtures by various governments to amalgamate the systems and allow cross practice appear totally irrational and driven by considerations other than the best interests of the patient.
If the training provided by a particular system of medicine met expectations with results, there will hardly be any incentive for crossing over. It is a sense of inadequacy that drives the need to gain entry into the allopathic system by back door methods. The argument that the curriculum in AYUSH covers the allopathic system to the extent of permitting cross practice is misleading. Every time the curriculum is modified, it merely incorporates more of the allopathic system and that too of limited components such as anatomy, physiology, pathology and community medicine. Regrettably instead of developing ISMs, such actions are sure to destroy these ancient systems. The claims of politicians to be working towards such development are therefore sheer hypocrisy. There are also vested interests. The Maharashtra Cabinet has taken a decision to permit cross practice in Maharashtra by homeopaths. The move was reportedly driven, in spite of stiff opposition, by a member with a stake in a homeopathic college.
Cross practice it is claimed, will solve the problem of inadequate healthcare facilities in rural areas. The inadequacy merely reflects the longstanding neglect of healthcare by every government since independence. A paltry budget of 0.9 to 1.2% of GDP is obviously never going to solve anything. Facilities in rural health centers remain pathetic. Doctors even in AIIMS have to go on strike for drinking water and toilets; and ad hoc remedies like cross practice are not the answer. The need for more medical colleges and better salaries has largely been ignored. The recommendations of various committees (Bhore 1946, Mudalier 1962, Mukherjee 1966 and ICMR 1981) right up to the most recent Mashelkar report have merely gathered dust.
Cross practice will precipitate chaos, besides exposing patients to unwarranted risks ending in mishaps and even fatalities. The Supreme Court, in a number of judgments has ruled against cross practice using terms like “quack…mere pretender…a charlatan”. Indeed if cross practice is to be allowed, a number of central acts need to be amended, like the IMC Act, the Pharmacy Act and the Drugs and Cosmetics Act among others.
Parrikar as CM reassured a delegation from the Medical Council and the IMA that cross practice would not be permitted in Goa. In his absence, as in so many other issues, somersaults and insanely short-sighted aspirations are in fashion.
(Dr Gladstone D’Costa is the Chairman, Accreditation Committee and member, Executive Committee, Goa Medical Council.)
